Role of febuxostat in retarding progression of diabetic kidney disease with asymptomatic hyperuricemia
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Date
2018-06-13
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Abstract
Introduction: Hyperuricemia is associated with chronic kidney disease (CKD) progression and poor cardiovascular
outcomes. We studied the effect of febuxostat on estimated glomerular filtration rate (eGFR), proteinuria
and monitored the safety profile of the medication.
Material and Methods: This is a prospective open-label, randomized study in CKD stage 3 and 4 patients with
diabetic nephropathy and asymptomatic hyperuricemia. Patients were randomized into febuxostat 40 mg daily and
no treatment group using block randomization method and were followed up for 6 months. Their usual care for
diabetes mellitus, hypertension and dyslipidemia were continued in the study. Blood and urine investigations were
monitored at baseline, 3 months and 6 months.
Results: The eGFR in febuxostat group was stabilized at 6 months with no significant reduction [26.2 (IQR 14.30)
at baseline to 26.3 (IQR 15.2) ml/min/1.73 m2]. Whereas, there was a significant reduction of the eGFR in no
treatment group from 28.2 (IQR 17.9) to 27.6 (IQR 19.3) ml/min/1.73 m2 (p value < 0.01). We found the HbA1c
(glycosylated hemoglobin) was significantly increased in febuxostat group from 7.2 ± 0.5 % at baseline to 7.6 ±
1.4 at 6 months (p value 0.04) but no significant change of HbA1c in the no treatment group. Proteinuria level was
unchanged in both groups. The commonest adverse event was joint pain.
Conclusions: Febuxostat was able to preserve eGFR in CKD patients with diabetic nephropathy and this effect
was beyond glycemic control. Increment of HbA1c level in febuxostat group needs further larger trials.
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Keywords
Febuxostat, Proteinuria, Chronic kidney failure, HbA1c, Hyperuricemia